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Viscoelastic tests in liver disease: where do we stand now?

World Journal of Gastroenterology 2021年第23期27卷 3290-3302页

作者： alina buliarca Adelina Horhat Tudor Mocan Rares Craciun Bogdan Procopet Zeno Sparchez The Third Medical Department “Iuliu Hatieganu”University of Medicine and PharmacyInstitute for Gastroenterology and Hepatology“Prof.Dr.O.Fodor”Cluj-Napoca 400162Romania

Hemostasis is a complex physiological process based on the balance between procoagulant and anticoagulant systems to avoid pathological bleeding or *** changes in standard coagulation tests in liver disease were assumed to reflect an acquired bleeding disorder,and cirrhotic patients were considered naturally *** the light of the new evidence,the theory of rebalanced hemostasis replaced the old *** to this model,the hemostatic alteration leads to a unique balance between pro-coagulant,anticoagulant,and fibrinolytic *** the balance is fragile and may prone to bleeding or thrombosis depending on various risk *** standard coagulation tests[INR(international normalized ratio),platelet count and fibrinogen]only explore parts of the hemostasis,not offering an entire image of the *** thromboelastometry(ROTEM)and thromboelastography(TEG)are both point of care viscoelastic tests(VET)that provide real-time and dynamic information about the entire hemostasis process,including clot initiation(thrombin generation),clot kinetics,clot strength,and clot stability(lysis).Despite prolonged PT/INR(international normalized ratio of prothrombin time)and low platelet counts,VET is within the normal range in many patients with both acute and chronic liver ***,bleeding remains the dominant clinical issue in patients with liver diseases,especially when invasive interventions are *** has been shown to asses more appropriately the risk of bleeding than conventional laboratory tests,leading to decrial use of blood products *** clotting is common but often subtle and may be challenging to predict even with the help of *** VET has shown its benefit,more studies are needed to establish cut-off values for TEG and ROTEM in these populations and standardization of transfusion guidelines before invasive interventions in cirrhotic patients/orthotopic liver transplantation.

关键词： Liver diseases Viscoelastic tests Portal vein thrombosis Acute-on-chronic liver failure Bleeding risk Invasive procedures

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